Prognostic factors for patients with hepatocellular carcinoma with macroscopic portal vein or inferior vena cava tumor thrombi receiving external‐beam radiation therapy

Abstract

Prognostic factors in patients with hepatocellular carcinoma (HCC) with tumor thrombosis are not well established, especially for those given external-beam radiation therapy (EBRT). Patients (n = 136) with HCC who had portal vein (PV) or inferior vena cava (IVC) tumor thrombus received EBRT between January 1998 and October 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined at diagnosis and before EBRT. The total radiation dose ranged from 30 to 60 Gy (median, 50 Gy) and was focused on the tumor thrombi. Predictors of survival were identified using the univariate and multivariate analysis. Of the 136 patients, the tumor thrombus completely disappeared in 41 patients (30.1%), 36 patients (26.5%) had a partial response, 49 patients (36%) had stable disease, and 10 patients (7.4%) had progressive disease. On multivariate analysis, pretreatment unfavorable predictors were associated with lower albumin, higher g-glutamyltransferase and a-fetoprotein levels, poorer Child-Pugh classification, intrahepatic multifocality, lymph node metastases, poorer response to EBRT, and 2-dimension EBRT technique. Survival rates at 1, 2, and 3 years were 31.8%, 17.5%, and 8.8% for patients with PV tumor thrombi; 66.3%, 21.1%, and 15.8% for IVC tumor thrombi; and 25%, 8.3%, and 0% for PV plus IVC tumor thrombi, respectively. Overall median survival was 9.7 months. This study provides detailed information about the survival outcomes and prognostic factors of HCC with tumor thrombi in a relatively large cohort of patients treated with radiation, and the results will help in understanding the potential factors that influence survival for patients with HCC after EBRT. (Cancer Sci 2008; 99: 2510-2517)

Effectiveness of High-dose Three-dimensional Conformal Radiotherapy in Hepatocellular Carcinoma with Portal Vein Thrombosis

“…All of these are not unique. So we reviewed patients' characteristics of other similarity designed studies which showed relatively shorter survival periods for non-responders (2,14). Although it is not directly comparable, our study included more patients who received TACE (93%) than the studies of Zeng et al and Kim et al (66 and 59.3%, respectively), and HAI was mentioned only in our study.…”

Prognostic Values of Vascular Endothelial Growth Factor and Matrix Metalloproteinase-2 in Hepatocellular Carcinoma after Radiotherapy

“…Many studies have shown that radiotherapy is an effective treatment for intermediate/advanced HCC, especially when transarterial chemoembolization cannot induce complete necrosis of HCC tumors [22,23], when tumor thrombosis is present in the portal vein or inferior vena cava [24,25], or when abdominal lymph node metastasis is present [26]. In the present study, we analyzed serum VEGF and urine MMP-2 and MMP-9 levels before and after radiotherapy in patients with HCC.…”

Optimal Selection of Radiotherapy as Part of a Multimodal Approach for Hepatocellular Carcinoma

“…However, PVTT is sensitive to RT, and the response rate ranges from 25% to 61.5% [52,[55][56][57][58]. Furthermore, RT can boost the treatment responses of tumors and PVTT, and thus likely bestows a survival benefit [33,52,[59][60][61][62]. In one retrospective study, preoperative RT induced PVTT necrosis in 8 patients (53.3%), and preoperative RT followed by surgery resulted in better outcomes than surgery alone for HCC with PVTT (5-year survival rate: 34.8% vs. 13.1%, p=0.0359) [61].…”